There is a lot of speculation about fasting, i.e., cutting out on eating for a period of time. Is it safe for a diabetic patient to fast or keep Roza? Will it help to control blood sugar or maybe rely less on medications?
Perhaps, some studies and investigations suggest that it is safe for a diabetic patient to fast. But obviously, fasting cannot be regarded as a technique to manage blood sugar levels. Moreover, Muslims fast for about a month during Ramadan. Ramadan is a lunar-based and holy month of Islam. Fasting in Islam is called “Roza.” This raises another question that whether it is safe for a diabetic patient to keep Roza or not?
What is Roza?
Roza is an obligatory duty performed by Muslims in the holy month of Ramadan. The duration of Ramadan varies from 29 to 30 days. The Roza starts at predawn, and Muslims break the Roza or fast at sunset. So, the duration of the Roza varies with seasons. This restricts muslims from eating and drinking anything, taking oral medications, or smoking. After breaking the fast, there are no restrictions on both eating and drinking.
Fasting in Islam is not meant to place an excessive burden on a Muslim. The Holy book, Quran, exempts the sick from fasting during Ramadan. Diabetic patients fall under this category. However, if the diabetic patient does not experience hypoglycemia or other issues, it is safe for the diabetic patient to keep a Roza.
Types of fasting
There are a few different types of fasting that people undertake. Intermittent fasting is one of them, which involves a specific pattern of keeping a fast and then eating normally.
This is a type of fasting where you get all your calories for the day by eating at one time. For example, you eat according to a 10-hour plan and then not eat for the rest of the hours. Time-restricted eating shows potential benefits for people with diabetes.
Alternate day fasting
In this type of fasting, you eat your regular meal for one day and then reduce the intake of calories on the next day. You follow this pattern for a week or so. Alternate fasting can reduce fasting blood sugar levels in diabetic patients.
Muslims follow the time-restricted fasting pattern for a month. They fast from dawn till dusk. It is safe for diabetic patients to keep Rozaduring Ramadan as long as they keep a check on the blood sugar levels. Moreover, fasting for 24 hours can be dangerous for patients with diabetes mellitus.
What are the benefits of keeping Roza to a diabetic patient?
Fasting may prove beneficial for diabetic patients in many aspects.
- Fasting (Roza) helps with maintaining blood sugar levels and helps with insulin resistance.
- It may help diabetic patients to lose weight. Your body stores excess glucose in the form of glycogen in the liver. When you are fasting, this glycogen is broken down, and once glycogen stores deplete, your body starts breaking out the fat. This helps you lose weight. Weight loss can, in turn, improve your HbA1c levels (a record of your blood sugar levels in the past 2-3 months).
- Fasting also helps diabetic patients to rely less on medications and cut down on their insulin dose.
In light of all these benefits, we can say that it is safe for diabetic patients to keep Roza during Ramadan. But, there are some risk factors too.
What are the risk factors associated with fasting for diabetic patients?
The most considerable risk that a diabetic patient might face is hypoglycemia (lowered blood sugar levels). While fasting, your blood sugar levels can go extremely low. This can result in fainting, body shaking, or the patient can even slip into a coma. Hypoglycemia is especially dangerous for heart patients suffering from diabetes mellitus.
Your blood sugar levels can drop to dangerous levels if you use any medication or insulin to control your blood sugar levels. So it is not safe for a diabetic patient to keep Roza if he/she experiences hypoglycemia.
Fasting might give you a headache. This is because you remain hungry for a couple of hours.
When you break your fast, your blood sugar levels can soar up rapidly. Doctors call this condition hyperglycemia. This condition is also dangerous for diabetic patients. Nevertheless, you can control this by avoiding carbohydrate-rich foods, as carbohydrate-rich foods can increase blood sugar levels.
4. Diabetic ketoacidosis
Diabetic patients who keep Roza during the month of Ramadan are at an increased risk for developing diabetic ketoacidosis, especially if they were hyperglycaemic before Ramadan. This can also happen due to cutting down insulin dosage with the view that there is decrease diet during Ramadan.
Limiting water intake while keeping Roza can result in dehydration. This can occur especially in hot climates and in individuals who perform strenuous exercises or workout routines. Additionally, hyperglycemic patients exhibit osmotic diuresis and show fluid and electrolyte depletion.
Things to do before a diabetic patient starts keeping Roza
Consult your doctor first
If you are a diabetic patient, consult your doctor before you try to keep Roza(s). Inform your doctor if you have any underlying health condition other than diabetes mellitus, have diabetes type I, or have experienced hypoglycemia before. In these cases, your doctor might recommend you not to keep Roza.
If your doctor gives you the green signal, ask him/her whether you should check your blood sugar levels while fasting or your medications need any adjustments in time or dosage.
Drink plenty of water to prevent dehydration. Dehydration can alter blood sugar levels and can keep it hard to maintain blood sugar levels.
Keep a check on blood sugar levels
If you start to feel confused, sweaty, or shaky, check your blood sugar levels. Provided that they are low, eat a date or have some glucose-laden drink. In case you often experience hypoglycemia, inform your doctor and get a consultation that whether you should keep Roza or not.
Do not overexert while keeping Roza
Remember not to try tough workout sessions or hard exercise while fasting. This can lead to hypoglycemia which can be dangerous. Ask your doctor about the activities you can perform or the activity level a diabetic patient needs to follow to avoid such situations while keeping Roza.
Be careful of what you eat while “breaking” your Roza
Muslims usually break their Roza with a date. But if you are a diabetic patient, do not go for dates while breaking your fast. This can increase your blood sugar levels leading to hyperglycemia. Instead, break your fast with plain water.
Management of the diabetic patients before putting them to fasting
The decision to fast lies on the diabetic patient after taking into consideration all the religious exemptions and after discussing all the associated risk factors and precautions with the doctor or diabetologist. The recommendation would probably be not to keep Roza.
However, diabetic patients that insist on fasting should be well aware of the risk factors associated with fasting. They should also be ready to follow all necessary precautions and guidelines given by their doctor to enjoy a good fasting experience. Let’s discuss the management plan now:
1. Individualized management plan
It is worth remembering that the management plan is individualized. This means that it differs from person to person.
2. Monitoring blood glucose levels
It is crucial to monitor blood sugar levels several times daily. For this purpose, keep a glucometer at home for convenience. Monitoring glucose levels is especially important in type II diabetes mellitus patients who are using insulin.
3. Physical Activity
A minor amount of physical activity is considered safe in Roza. However, recommendations are to avoid excessive physical activity or hard workout routines. This can lead to hypoglycemia in diabetic patients.
Nutrition during Ramadan should be a balanced diet. Increase fluid intake during the non-fasting hours. Suhoor (meal at predawn before starting Roza) should be taken as late as possible.
5. In case of hypoglycemia
If the diabetic patient experiences hypoglycemia before breaking Roza, the recommendation is to break the fast immediately. If the blood sugar levels go down to less than 70 mg/dl, it is advisable to break the fast because the patient can’t be sure whether his/her blood sugar levels will improve or not.
6. In case of hyperglycemia
If the diabetic patient experiences hyperglycemia with blood glucose levels above 300 mg/dl, recommendations are to break the Roza as soon as possible. Do not consume dates to break the Roza. If the blood glucose levels remain higher, do not fast for the next few days. Consult your health care provider before keeping fast.
7. Medical assessment before the beginning of Ramadan
Medical assessment of the diabetic patient before Ramadan is a necessary requisite. Pay special attention to blood sugar levels to see if they are stable or not. Moreover, put the patient in an effective and stable medication program before he/she initiates fasting in Ramadan.
Management of Diabetic patients before starting Roza(s) based on medications programs
Management of diabetic patients is individualized and is based on medication plans which the patient follows.
Patients on metformin therapy can safely continue taking the medication because the risk of hypoglycemia is minimal. However, the dosage needs to be adjusted.
Sulfonylureas are a group of drugs that are absolutely contraindicated in fasting diabetic patients during Ramadan. This is due to their high risk of hypoglycemia. However, newer generation sulfonylureas such as glyburide and glimepiride can be used with caution.
Glitazones are safe to use in diabetic patients who keep Roza. Also, there is no requirement for a change in dosage.
Short-acting insulin secretagogues cause the release of insulin from pancreatic cells. These medications can be taken twice daily at predawn and dusk, i.e., before starting and after breaking the Roza. Moreover, the risk of hypoglycemia is also minimal.
5. Insulin Therapy
The goal during Ramadan is to maintain basal insulin levels in fasting diabetic patients. To achieve this, one injection of long-acting insulin such as insulin glargine or two injections of intermediate-acting insulin such as insulin detemir or NPH at predawn and dusk can help maintain basal insulin levels in Roza.
A little Comprehension
In brief, fasting in Ramadan for diabetic patients carries the risk of certain complications. Patients of diabetes mellitus type I are strongly recommended not to keep Roza during Ramadan, especially if they face hypoglycemia or poorly controlled blood sugar levels.
However, diabetes mellitus type II patients can safely keep Rozas during the month of Ramadan as there is a reduced risk of hypo- or hyperglycemia in these patients. With this in mind, the patient should decide to fast after a thorough discussion with the health care provider and after considering all religious exemptions.
Yes, it is safe for diabetic patients to fast during the month of Ramadan as long as the patient follows all necessary precautions and guidelines of the doctor. The decision lies on the patient, however. If the patient experiences hypoglycemia or hyperglycemia during fasting, he/she can break the Roza because the patient can’t be sure whether his blood glucose levels will improve or not.
No, it is not advisable to break Roza with a date for a diabetic patient. It can lead to hyperglycemia which is dangerous for the patient. You can use plain water to break your fast.
Yes, adjustment of the medication dose is essential before a diabetic patient decides to keep Roza in Ramadan. For this purpose, medical assessment before the beginning of Ramadan is required. Your doctor may adjust the dose if you are taking metformin, insulin secretagogues, or injecting insulin. However, doctors might stop sulfonylureas altogether, and the patient may be switched to another class of drug. Moreover, glitazones do not require a change in dosage.
It is safe to practice moderate or low levels of physical activity for a diabetic patient while keepingRoza. But, there is not recommendations of a hard workout routine or excessive physical activity while fasting. This can lead to hypoglycemia which can prove dangerous for the diabetic patient.
Although it is relatively safe for diabetic patients to fast or keep Roza, a few risk factors can be associated with fasting. Hypoglycemia tops the list. If the patient experiences hypoglycemia, he/she can break the fast to avoid any possible risks of fainting spells or, in more dangerous situations, coma. Additionally, diabetic ketoacidosis, hyperglycemia, headaches, and dehydration are some other risk factors.